Groups Call for Repeal of Medicare Payment Advisory Board

IPAB is 'fatally flawed' and a 'blunt instrument'

The Affordable Care Act's Independent Payment Advisory Board (IPAB) is a bad idea and should be repealed, according to a coalition of more than 600 healthcare organizations.

"IPAB is not a tool to improve the value of the Medicare program," Mary Grealy, president of the Healthcare Leadership Council, the group that is spearheading the repeal push, said during a teleconference last week. "Rather, it's a blunt instrument intended to reduce what Medicare pays for treatment. IPAB was a fatally flawed concept from its inception, and now, as we're on the verge of its activation, it's a very real danger and needs to be prevented."

The IPAB was designed to be a 15-member independent body that would make recommendations on cuts to the Medicare budget; if Congress didn't agree with the IPAB's recommendations, it would have to devise its own plan to cut the Medicare budget by an equivalent amount.

That idea was so controversial that no members were ever appointed to the board and it has never met. But that could change next year, when -- according to Medicare's board of trustees -- projected per-capita Medicare spending is expected to exceed its target; such an occurrence would require the IPAB to meet and act, according to the law.

"When all groups agree on something, it really does send a signal about IPAB that this should be taken seriously," former senator Kay Hagan (D-N.C.) said on the call. "When I was a senator I heard these same concerns."

"In 2013 I co-sponsored legislation to repeal IPAB," continued Hagan, who is now a senior policy consultant with the Akin Gump law firm in Washington. "I believed then, and I believe now, that IPAB is the wrong way to try to hold down Medicare spending. It delegates way too much authority to the IPAB board and takes authority away from Congress, and puts it in the hands of the Health and Human Services Secretary without any judicial oversight." The House voted to repeal IPAB in 2012, but the Senate has never followed suit.

In addition, IPAB would operate with a total lack of transparency, said Andrew Sperling, director of federal affairs at the National Alliance on Mental Illness, a mental health advocacy group in Arlington, Va. He compared it to the Base Closure and Realignment Commission, a group charged with deciding which military bases would be closed.

"[The commission] was required to hold open meetings ... and had public meetings and open records," Sperling said. "They voted in public. IPAB would be bound by none of this; it would meet in secret." And IPAB members cannot hold another job while they're serving on IPAB, so policy experts in academia would be barred from serving on it. "So for lack of a better term, dumbing down the expertise would be part of this panel."

Finally, the IPAB requirements "bar administrative and judicial review, so if a beneficiary group or patient group were unhappy with IPAB's recommendations, it would not have the ability to go into federal court to block their implementation. I'm concerned this ... would not serve the interests of patients very well," said Sperling. "We need an open, transparent process where [hard decisions are made by elected officials] and patients can hold members accountable at the ballot box."

Alex Valadka, MD, president-elect of the American Association of Neurological Surgeons, expressed concerns about what would happen if the IPAB convened and recommended cuts to the budget for educating physicians. "The healthcare dollar is shrinking more and more; as IPAB [shrinks Medicare's budget], it's going to be harder and harder to train the next generation of physicians, much less sustain the system we have right now," he said.

The coalition has established a website entitled "Protect My Doctor and Me" to raise awareness about IPAB, Grealy said. "We're going to engage, to really educate members of Congress, and generate more bipartisan support to get this legislation passed in Congress," she said. "There is great bipartisan interest in the House, and they are working on it in the Senate as well."

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.